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Physician Communication and Patient Adherence to Treatment: A Meta-Analysis

Haskard Zolnierek, Kelly B. PhD*; DiMatteo, M Robin PhD

doi: 10.1097/MLR.0b013e31819a5acc
Original Article

Background: Numerous empirical studies from various populations and settings link patient treatment adherence to physician-patient communication. Meta-analysis allows estimates of the overall effects both in correlational research and in experimental interventions involving the training of physicians’ communication skills.

Objectives: Calculation and analysis of “r effect sizes” and moderators of the relationship between physician's communication and patient adherence, and the effects of communication training on adherence to treatment regimens for varying medical conditions.

Methods: Thorough search of published literature (1949–August 2008) producing separate effects from 106 correlational studies and 21 experimental interventions. Determination of random effects model statistics and the detailed examination of study variability using moderator analyses.

Results: Physician communication is significantly positively correlated with patient adherence; there is a 19% higher risk of non-adherence among patients whose physician communicates poorly than among patients whose physician communicates well. Training physicians in communication skills results in substantial and significant improvements in patient adherence such that with physician communication training, the odds of patient adherence are 1.62 times higher than when a physician receives no training.

Conclusion: Communication in medical care is highly correlated with better patient adherence, and training physicians to communicate better enhances their patients’ adherence. Findings can contribute to medical education and to interventions to improve adherence, supporting arguments that communication is important and resources devoted to improving it are worth investing in. Communication is thus an important factor over which physicians have some control in helping their patients to adhere.


From the *Department of Psychology, Texas State University, San Marcos, Texas; †Department of Psychology, University of California, Riverside, California.

Supported by a Robert Wood Johnson Foundation Investigator Award in Health Policy Research (PI: Robin DiMatteo), by a grant from the National Institute on Aging 5R03AG27552-02 (Principal Investigator: Robin DiMatteo), and by the Committee on Research of the U.C. Riverside Academic Senate.

The views expressed in this paper are those of the authors alone and do not imply endorsement by the funding sources.

An earlier version of the data set presented here appeared in a poster session at the 2007 annual meeting of the Society for Behavioral Medicine in Washington, DC.

Reprints: Kelly B. Haskard Zolnierek, PhD, Department of Psychology, Texas State University, 601 University Avenue, San Marcos, Texas 78666. E-mail:

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© 2009 Lippincott Williams & Wilkins, Inc.